Malaria and acute kidney injury.

Malaria is a major public health problem in tropical countries. About 500 million people suffer from malaria, leading to death in 1 to 3 million cases. Acute kidney injury (AKI) is one of the most dreaded complications of severe malaria. As per World Health Organization criteria, acute renal failure (serum creatinine level, > or =3 mg/dL or > or =265 micromol/L) occurs as a complication of Plasmodium falciparum malaria in less than 1% of cases, but the mortality rate in these cases may be up to 45%. It is more common in adults than children. Renal involvement varies from mild proteinuria to severe azotemia associated with metabolic acidosis. It may be oliguric or nonoliguric. AKI may be present as a component of multi-organ dysfunction or as a lone complication. The prognosis in the latter is generally better. Several pathogenic mechanisms interplay for the clinical manifestation. The predominant lesions are acute tubular necrosis and mild proliferative glomerulonephropathy. These patients do not progress to chronic kidney disease. The management of malaria-induced AKI includes appropriate antimalarials (parenteral artesunate or quinine), fluid electrolyte management, and renal replacement therapy at the earliest. The use of diuretics should be avoided.